• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제13권1호
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• pp.153-162
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• 2002

요 약：본 연구에서는 어머니의 우울감과 양육 스트레스, 양육 효능감 및 역기능적 사고 등 양육 관련 태도가 부모의 양육 행동에 미치는 영향을 살펴보았으며, 특히 주의력결핍과잉행동장애 아동 어머니를 중심으로 살펴보았다. 방 법：대상은 DSM-Ⅳ 진단 준거에 의한 정신과 전문의의 소견과 심리학적 진단 평가 하에 주의력결핍과잉 행동장애로 진단된 아동 31명의 어머니였고 연령 범위는 28세에서 44세였다. 비교 집단으로는 동일 연령대의 정상 아동 51명의 어머니를 대상으로 하였으며, 연령 범위는 32세에서 45세였다. 주의력결핍과잉행동장애 아동의 연령 범위는 6세에서 11세까지(남자 29명, 여자 2명)였고, 비교 집단은 선별 검사로 진단적 평가 척도(DRS)의 부모용과 교사용을 사용하여 주의력결핍과잉행동장애가 아닌 것으로 밝혀진 6세에서 11세까지의 아동(남자 21명, 여자 30명)이었다. 모든 아동의 어머니에게 우울감 및 양육 관련 태도를 측정하기 위해 부모용 질문지 배터리를 실시하였으며 Student's t-test와 상관 분석, 단계적, 위계적 회귀 분석을 실시하였다. 결 과：상관분석에서 강압적 양육 행동이 주의력결핍과잉행동장애 아동 부모에게서 높게 나타났고, 양육 관련 태도도 더욱 부정적인 결과를 보였으며 우울 역시 더 높게 보고되었다. 회귀 분석 결과, 어머니의 양육 스트레스, 역기능적 사고와 양육 효능감 그리고 어머니의 우울감은 강압적 양육행동의 50%를 유의미하게 예측하는 변인임이 밝혀졌는데, 어머니의 우울감이 강압적 양육 행동의 29%를 유의미하게 설명하고 있어, 우울감을 느끼는 경우 더욱 강압적 양육행동을 보일 수 있음이 시사되었다. 따라서 주의력결핍과잉행동장애 아동 부모의 경우, 아동의 증상이 양육 스트레스를 야기하고, 높은 역기능적 사고와 낮은 양육 효능감으로 더욱 우울감이 심화될 가능성이 높고 결국에는 아동에게 강압적 양육 행동을 나타내는 악순환이 나타나는 것으로 생각된다. 결 론：주의력결핍과잉행동장애 아동의 어머니의 경우, 높은 양육 스트레스와 낮은 양육 효능감 및 아동과의 관계에서의 역기능적 사고의 영향 뿐 아니라 부모 자신의 우울감이 강압적인 양육 행동에 영향을 미침을 시사한다. 따라서 부모의 강압적인 양육행동을 변화시키기 위해서는 주의력결핍과잉행동장애 아동 부모의 양육 스트레스, 아동에 대한 역기능적 사고 및 양육 효능감을 다루어야 할 뿐 아니라, 부모의 우울감을 치료 시 고려해야 할 것이다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제31권4호
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• pp.214-224
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• 2020

Objectives: This study aimed to examine the trend in diagnostic prevalence of psychiatric disorders in children and adolescents. Methods: Individuals aged 0-18 years were included in the study based on the National Health Insurance Claims Data. To investigate the trends in diagnosis and diagnostic prevalence of psychiatric disorders reflecting the decrease in the birth rate, data were analyzed from 2010 as a reference year to 2015. Results: The number of patients diagnosed with psychiatric disorder decreased annually, from 23,412 on 2010 to 18,821 on 2015. The most common disorder was hyperkinetic disorder in male and depressive episode in female. Although there was no significant change in overall diagnostic prevalence rate of psychiatric disorders, age groups <10 years and some disorders had significant changes in prevalence rate. This study classified the diagnostic prevalence by age into two unique patterns: group in which the diagnosis rate increases with age and group in which the diagnosis rate peaks at a certain age and then decreases. Conclusion: Diagnostic prevalence of psychiatric disorders was different according to age and sex. These patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients. It is urgent to identify how these patterns change in young adults.

• 생물정신의학
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• 제3권1호
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• pp.102-108
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• 1996

본 연구는 한국인의 우울증 환자에서 moclobemide가 효과적이며 안전하게 사용될 수 있음을 입증하였으며, 투약 방법으로 초기 권장량인 1일 300mg을 2회 분복시키는 방법이 추천될 수 있음을 확인하였다.

• 정신신체의학
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• 제15권2호
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• pp.100-106
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• 2007

연구목적 : 본 연구는 주요 우울장애 환자들과 준임상적 우울증 환자들의 감정표현불능증 정도를 조사하기 위해 시행되었다. 방법 : 지역사회에 거주하는 386명(남/여=148/238, 평균 연령 : $43.0{\pm}13.9$, 연령 범위 : 19~79)이 연구에 참여했다. 구조화된 임상면담(Structured Clinical Inteview for DSM-IV, SCID)를 이용하여 주요 우울장애 및 기타 1축 정신질환을 진단했다. 우울증상를 평가하기 위해 역학연구센터 우울척도(the center for epidemiologic studies-depression scale, CES-D)를 자가 작성하게 했다. 감정표현불능증은 토론토 감정표현불능증 척도(Toronto alexithymia scale, TAS)로 평가했다. 주요 우울장애의 병력이 없는 이 중 SCID에서 경도 우울장애가 있거나, CES-D 점수가 16점 이상인 경우를 준임상적 우울증으로 정의했다. 주요 우울장애군, 준임상적 우울증군, 정상 대조군 세군으로 나누어 TAS 총점과 각 요인별 점수를 비교했다. 결과 : 전체 386명 중, 38명(9.8%)이 DSM-IV 주요 우울장애의 진단 기준에 부합하는 병력이 있었고, 57명(14.8%)이 준임상적 우울증군으로 분류되었다. 각 군간 TAS 총점($F_{2,383}=14.0$, p<0.01), 요인 1(감정인식의 장애) ($F_{2,383}=23.4$, p<0.01), 요인 2(감정표현의 장애)($F_{2,383}=7.8$, p<0.01)에 차이가 있었다. TAS 요인 3(외부지향적 사고)는 유의한 차이가 없었다($F_{2,383}=1.8$, p=0.16). 주요 우울장애군과 준임상적 우울증군은 모두 대조군에 비해 TAS 총점, 요인 1, 요인 2의 점수가 높았다(모두 p<0.01). 반면, 주요 우울장애군과 준임상적 우울증군은 TAS 총점 및 각 요인 점수에서 유의한 차이가 없었다. 결론 : 준임상적 우울증 환자는 우울증상이 없는 대조군에 비해 감정표현불능증이 더 심했다. 한편, 주요 우울장애와 준임상적 우울증은 감정표현불능증에서 유의한 차이가 없었다. 이러한 결과는 감정표현 불능증이 주요 우울장애 뿐아니라 준임상적 우울증과도 관계있음을 시사한다.

• 생물정신의학
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• 제20권2호
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• pp.45-53
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• 2013

Objectives Non-major depression with fewer symptoms than required for a Diagnostic and Statistical Manual of Mental Disorders-4th edition diagnosis of major depressive disorder (MDD) has consistently been found to be associated with functional impairment. In this study, we aim to estimate the cognitive impairment and the quality of life in elderly patients with subsyndromal depression (SSD) compared with non-depressive elderly (NDE). Methods The Korean version of Mini International Neuropsychiatric Interview was administered to 194 outpatients with depression and 108 normal controls. SSD is defined as having five or more current depressive symptoms with core depressive symptoms (depressive mood or loss of interest or pleasure) during more than half a day and more than seven days over two weeks. Depression was evaluated by the Korean form of Geriatric Depression Scale of a 15-item short version. Global cognition was assessed by Mini-Mental State Examination in the Korean version of CERAD assessment packet (MMSE-KC). Subjective cognitive impairment was assessed by the Subjective Memory Complaint Questionnaire. Quality of life was evaluated by the Korean Version of Short-Form 36-Item Health Survey. Results The mean score of the MMSE-KC in the SSD group was lower than that in the NDE group with adjustment for age, gender, and education [F = 4.270, p = 0.04, analysis of covariance (ANCOVA)]. If we defined those having Z-score of MMSE-KC < -1.5 as a high risk group of cognitive impairment, the odds ratio for the high risk group of cognitive impairment was 1.86 [95% confidence intervals (CI) 1.04-3.34] in SSD and 7.57 (95% CI 3.50-16.40) in MDD compared to NDE. The scores of physical component summary (F = 9.274, p = 0.003, ANCOVA) and mental component summary (F = 53.166, p < 0.001, ANCOVA) in the SSD group were lower than those in the NDE group with adjustment for age, gender, and education. Conclusions The subjects with SSD, as well as those with MDD, showed impairment of global cognition and also experienced low quality of life in both physical and mental aspects, compared to the NDE group.

• 생물정신의학
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• 제12권2호
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• pp.207-215
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• 2005

Objectives:This study was to compare verbal memory ability among patients with schizophrenia, bipolar manic patients and unipolar depressive patients, and to understand their charicteristics of memory process. Methods:All subjects were hospitalized patients and had been interviewed by using the Structured Clinical Interview for DSM-IV(SCID). Schizophrenic patients(N=40), bipolar manic patients(N=17), and unipolar depressive patients(N=20) were assessed with K-AVLT for verbal memory and with K-WAIS for verbal IQ. Three groups were compared regarding total immediate recall, delayed recall, delayed recognition, learning curve, memory retention, and retrieval efficiency under controlled verbal IQ. Multiple regression analysis was performed to find which clinical factors have an influence on verbal memory ability. Results:In MANCOVA, differences of verbal memory test scores among the groups were statistically significant(F=1.800, p<.05). In post hoc analysis, Patients with schizophrenia and bipolar mania showed poorer performance in immediate recall, delayed recall, delayed recognition, retrieval efficiency than unipolar depres- sive patients. And schizophrenics performed poorly in delayed recall, delayed recognition, retrieval efficiency than nonpsychotic affective disorder group, but no difference in total immediate recall, delayed recall, delayed recognition, retrieval efficiency between the schizophrenic group and the psychotic affective group. Conclusions:These results partially confirm previous reports of verbal memory ability among major psychiatric disorders. Our results showed that psychotic symptoms were related with verbal memory, and longer duration of illness was related with poorer performance in schizophrenia and unipolar depression.

• 대한불안의학회지
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• 제16권1호
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• pp.32-40
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• 2020

Objective : The purpose of this study was to investigate the cognitive performance of major depressive disorder (MDD) in military service/conscription personnel who visited the psychiatric clinic for a medical certificate to consider the situation from the perspective of Korea's unique compulsory military system. We used the Korean Wechsler Adult Intelligence Scale-IV (K-WAIS-IV) as the test for verifying the suitable level of cognitive functioning for military service and as the embedded measure with reflecting suboptimal effort. Methods : The study was conducted on 56 (28 males, age 19-34) in/out-patients admitted to the psychiatry department and diagnosed with MDD (DSM-IV). All participants completed a structured clinical interview (MINI-Plus), as well as self-report questionnaires related to demographics and severity of clinical symptoms. K-WAIS-IV was administered to each subject to assess cognitive characteristics. Results : Military group showed significantly lower processing speed index (PSI) score including subtests of symbol search (SS) and coding (CD) score, compared to the control group. There was no other significant differences in the Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) scores including sub-tests comprised of the above indices, and Reliable Digit Span (RDS), Enhanced-RDS-Revised (E-RDS-R) between the study and control groups. Conclusion : This study was the first effort to verify the characteristics of Korea's military group with MDD and suggest the applicability of PSI and processing speed of K-WAIS-IV as an embedded performance index to test sub-optimal effort or low motivation beyond the purpose of testing cognitive deficits.

• 정신신체의학
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• 제29권1호
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• pp.34-41
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• 2021

연구목적 본 연구는 우울 증상으로 정신건강의학과에 자문 의뢰된 환자들의 임상적 특징과 자문 의뢰 형태, 재협진 여부에 따른 차이를 알아봄으로써, 종합병원 입원환자의 우울장애의 특징을 조사하고자 하였다. 방 법 2005년 8월부터 2011년 12월까지 정신건강의학과에 자문 의뢰된 입원환자를 대상으로 하였고, 이중 우울증상으로 의뢰된 환자들의 의무기록을 후향적으로 분석하였다. 결 과 우울 증상으로 의뢰된 환자는 총 647명으로 전체 협진 중 13.82%에 해당하였다. 우울 증상으로 의뢰된 환자의 평균 나이는 58.6세로 전체 정신건강의학과에 협진 의뢰된 환자군의 평균 56.4세보다 높았으며, 3형 의뢰 형태(입원 이후 새롭게 발생한 정신건강의학과적 증상을 위한 협진 의뢰)가 가장 많았다. 이중 재협진 의뢰된 환자는 275명으로 전체의 42.5%였으며, 재협진군과 비재협진군을 비교해 보았을 때 통계적으로 유의미한 차이는 없었다. 그러나 자문 의뢰 형태에서 두 군의 산술적 차이가 있었는데, 재협진군은 3형(보수형)-2형(병렬형)-1형(상호보완형)의 빈도순을 보였고 반면, 비 재협진군은 2형(병렬형)-3형(보수형)-1형(상호보완형)의 빈도순을 보였다. 결 론 종합병원에서 우울 증상으로 의뢰된 환자군은 전체 정신건강의학과 협진 의뢰 환자 군에 비해 고령의 비율이 높았고, 그중 재협진군은 비재협진군에 비해 입원 이후 새롭게 증상이 발생하여 협진 의뢰된 비율이 높았다. 따라서 각 과 주치의들과 정신건강의학과 의사들은 입원환자들의 우울 증상에 주의를 기울이고, 적극적으로 치료계획을 논의함으로써 의료 서비스의 질을 향상시키고 위험 요인을 파악하여 필요하면 조기 개입할 수 있도록 노력해야 할 것이다.

• 노인정신의학
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• 제21권1호
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• pp.35-40
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• 2017

Objective : This study aimed to investigate the effect of community-based Goal-Achieving program in geriatric depressive symptoms preliminarily. Methods : We obtained data from elderly Korean subjects with major depressive disorder (n=51) aged 60 years or older at baseline, taking case management from community mental health center. Subjects were randomly assigned to intervention group (n=24) and control group (n=27). We investigated depressive symptoms through Short Form Geriatric Depression Scale-Korean version (SGDS-K) at baseline and every month for 3 months to all subjects. We tested interaction between group and time in SGDS-K score to evaluate the effect of program. And post hoc test examined between group differences of SGDS-K at each time points. Results : In quadratic linear mixed effects model analysis, interaction between group and time was statistically significant (Total SGDS-K score : coefficient=0.29, p<0.001 ; SGDS-K dysphoria subscale : 0.18, p<0.001 ; SGDS-K hopelessness subscale : 0.05, p=0.089 ; SGDS-K cognitive impairment subscale : 0.06, p=0.003). And significant between group difference was shown in post hoc test at time points of third month (SGDS-K score of control group : SGDS-K score of intervention group=$10.74{\pm}3.482$ : $7.25{\pm}4.475$, p=0.0184). Conclusion : These results may suggest that 'Community-based the Goal-Achieving program' has efficacy in reducing geriatric depressive symptoms.

• 대한불안의학회지
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• 제2권1호
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• pp.22-27
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• 2006

Objectives : There is a paucity of data on the long-term course of obsessive-compulsive disorder (OCD) and chronological relationship between OC symptoms and their related symptoms such as anxiety and depression. The purpose of this study was to investigate the longitudinal course of OC symptoms as well as anxiety and depression which are believed to be associated with OC symptoms. Methods : Data for 155 patients with OCD who completed general evaluation for OCD were used. Forty four were excluded to minimize the effect of the different age of onset on the clinical course. One hundred eleven patients finally participated in the analysis. Cross-sectional correlations between each symptom as well as between such symptoms and the duration of illness were analyzed. Further correlation analysis was done within two groups that were divided by 7 years of the duration of illness. Results : There were significant correlations not only between the severity of OC symptoms and anxiety but also between anxiety and depressive symptom, regardless of the duration of illness. These correlations between such symptoms were also found within patients with the duration of illness below 7 years, whereas these were not within the group with the duration of illness above 8 years. Conclusion : Patients with OCD in this study shows the moderate to severe level of OC symptoms irrespective of the duration of illness. Our finding also suggests that the OC symptoms, especially obsessions are closely related to anxiety and depressive symptoms and these relationships might be pronounced in relatively early phase of the OCD after onset.